Clinical ethics consultation for patients with eating disorders: a single center retrospective content analysis

Ethics consultation’s (EC) role in supporting healthcare professionals, patients, and families confronted by eating disorders (ED) is under-described in the literature. We used qualitative conceptual content analysis to characterize the ethical issues and contextual features of EC involving patients with Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge-Eating Disorder (BED), Avoidant Restrictive Food Intake Disorder (ARFID), or Other Specified Feeding or Eating Disorder (OSFED) and compared adult vs. pediatric settings at a single institution from 2015 to 2024. We identified 40 consultations (14 adult, 26 pediatric) for 25 patients (12 adult, 13 pediatric). Most were female (n = 18, 72%), White (n = 20, 80%), non-Hispanic (n = 23, 92%), and diagnosed with AN (n = 13, 52%); none were diagnosed with BED or OSFED. The primary ethical issue overall (n = 23, 57%) and in the pediatric setting (n = 20, 77%) was patient assent/treatment over objection. No single ethical issue was prominent in the adult setting. The most common contextual feature overall (n = 21, 52%) and within adult (n = 7, 50%) and pediatric (n = 14, 53%) settings was legal involvement. EC patterns suggest differences in ethical concerns based on setting and age; a tailored approach may be warranted. Our results raise concerns that EC is underutilized within subsets of the ED population, necessitating further research.